Limited National Potential for Reducing Anesthesia Clinician Staffing for Cataract Surgery: A Historical Cohort Study Using a Large United States Anesthesia Registry

Background Cataract surgery, the most frequently performed surgical procedure worldwide, is increasing, with many patients receiving intravenous sedation by anesthesia clinicians. Given anesthesia clinician shortages and ambulatory surgery facility scheduling constraints, some ophthalmologists are moving to office-based care without anesthesia services. We examined the potential impact of such a shift in care on reducing anesthesia clinician staffing. Methods We analyzed 622,953 cataract surgeries performed at 672 facilities between 2022 and 2023, using data from the American Society of Anesthesiologists' national anesthesia registry, to determine the proportion of shortest lists that exceeded four hours on regular workdays. The number of anesthesia clinicians staffing these cases, by facility, was determined from the counts of cases with overlapping care during each workday minute. The time for the number of simultaneously running operating rooms (ORs) to decrease permanently by one on a specified day corresponds to the completion of the facility's shortest list. Results There was at least one cataract case for 80.3% (95% CI 79.4% to 81.3%) of all combinations of facilities and workdays. Among all facilities, the proportion of time for the OR to complete its shortest list exceeded four hours for 84.3% of combinations of quarter of the year and day of the week (95% CI, 81.8% to 86.8%). Conclusions The complete removal of anesthesia clinician staffing would likely result in a substantive disruption to the cataract surgery workload, given the number of patients receiving care during half-day sessions and the probability that some patients will require an anesthesia clinician to manage their intraoperative care.